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ABSTRACT: T-fastener gastropexy is widely performed as part of gastrostomy insertion. The current literature recommends removal of T-fasteners at 2 weeks. We present a series of patients in whom T-fasteners were removed at 2 days with no major complications. We removed T-fasteners in 109 patients (male-to-female ratio 59:50, age range 18 to 88 years, mean age 62 years) at 2 days after gastrostomy insertion. Indications for gastrostomy included amytrophic lateral sclerosis, cerebrovascular accidents, head and neck carcinoma, multiple sclerosis, and others, including brain tumours and chronic inflammatory demyelinating polyneuropathy. No peritubal leaks or other major complications were seen in the study population. In the study group, 15 minor complications were recorded (14%), including localised infection and pain, both of which resolved on removal of T-fasteners. We conclude that it is feasible and safe to remove T-fasteners at 2 days.
CardioVascular and Interventional Radiology 01/2009; 32(2):317-9. · 2.09 Impact Factor
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ABSTRACT: Historically, fine-needle aspiration cytology (FNAC) has varying sensitivity, specificity and accuracy in the diagnosis of abdominal lesions with a high insufficient sampling rate. We compared 20-G fine-needle trucut biopsy (FNTB) with FNAC results in the biopsy of solid abdominal tumours. A retrospective review of 171 (128x 20-G FNTB and 43x FNAC) ultrasound-guided biopsies of abdominal tumours on 157 patients (male : female 85:72, mean age 61.25 years) were carried out. One hundred and seventy-one biopsies were carried out: liver 109, pancreas 19, lymph node 10, omentum 5, right iliac fossa mass 6, adrenal 6 and others 16. An average of 2.06 and 1.97 passes (range 1-4) were carried out per FNTB and FNAC, respectively. A definitive diagnosis was made in 122/128 biopsies (95.3%) and 32/43 biopsies (74.4%) for FNTB and FNAC, respectively. Diagnoses consisted of metastatic liver disease (74/171), pancreatic adenocarcinoma (10/171), lymphoma (8/171) and others (33/171) and benign (29/171). No significant complications occurred in either group. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 87, 100, 100, 50, 84.4 and 93.1, 100, 100, 60, 71.4 for FNTB and FNAC, respectively. A greater and more consistent positive diagnosis rate is yielded by 20-G FNTB (95.3%) than FNAC (74.4%). The diagnostic accuracy of FNTB is 84.4% compared with 69.8% for FNAC. A greater insufficient sampling rate occurs with FNAC (25.6%) than with FNTB (4.7%). For abdominal biopsy, 20-G FNTB needles have a much higher yield than FNAC with no increase in complications. FNTB is the preferred choice, particularly where cytological assistance at the time of biopsy is unavailable.
Journal of Medical Imaging and Radiation Oncology 07/2008; 52(3):231-6. · 0.87 Impact Factor
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ABSTRACT: We present the study of a 58-year-old man who underwent percutaneous management of a high-output chylothorax following cardiac bypass graft surgery. The patient presented to a peripheral hospital 3 weeks postoperatively following cardiac bypass graft surgery with shortness of breath. A chest radiograph taken on arrival to the emergency department showed a large left-sided pleural effusion. Subsequent intercostal chest tube insertion drained a large amount of chylous fluid. The patient was treated conservatively with no improvement until undergoing a CT-guided needle disruption of lymphatics with good effect. This case is presented to show the minimally invasive treatment methods that are available in the management of high-output chylothorax.
Journal of Medical Imaging and Radiation Oncology 05/2008; 52(2):164-7. · 0.87 Impact Factor
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ABSTRACT: Establishing and maintaining venous access forms an increasing proportion of the workload in interventional radiology. Several patient groups require medium-term to long-term venous catheters for a variety of purposes, including chemotherapy, long-term antimicrobials, parenteral nutrition, short-term access for haemodialysis or exhausted haemodialysis. Often, these catheters are required for treatment and frequent blood testing, which can quickly exhaust the peripheral veins. Long-term venous access devices minimize the discomfort of frequent cannulation while preserving the peripheral veins. Venous access devices include implantable catheters (ports), tunnelled catheters and peripherally inserted central catheters, which have different functions, advantages and limitations. Imaging-guided placement is the preferred method of insertion in many institutions because of higher success rates and radiologists are well suited to address catheter complications.
Journal of Medical Imaging and Radiation Oncology 03/2008; 52(1):10-7. · 0.87 Impact Factor
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ABSTRACT: Spontaneous nonhemophiliac hemarthrosis is an unusual entity, which has been little described. We present three cases of spontaneous recurrent hemarthrosis post total knee replacement (TKR) and successful management with embolization. Three male patients were referred to our service for angiography and treatment of recurrent hemarthrosis post TKR. In all three patients antegrade ipsilateral common femoral artery punctures and selective angiography of the geniculate branches were performed with a microcatheter. Abnormal vasculature was noted in all cases. Subsequent embolization was performed with Contour (Boston Scientific, Target Vascular, Cork, Ireland) embolization particles (150-250 and 250-355 microm) in two patients and microcoils in the third (TornadoR; Cook Inc., Bloomington, IN, USA). Technical success was 100%. One patient had a recurrence of symptoms requiring a repeat procedure 6 months later. No complications were encountered. Selective angiography and particle embolization is an effective technique for management of this unusual but problematic postoperative sequelae.
CardioVascular and Interventional Radiology 02/2008; 31(5):986-8. · 2.09 Impact Factor
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ABSTRACT: Creating a direct intrahepatic portocaval shunt (DIPS) is a procedure similar to a transjugular intrahepatic portosystemic shunt (TIPS) in patients for whom the latter is not appropriate due to unsuitable hepato-venous and porto-venous anatomy. We present a patient for whom TIPS was not possible, and DIPS successful.
Australasian Radiology 01/2008; 51 Suppl:B328-30. · 0.51 Impact Factor
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ABSTRACT: The use of percutaneous closure devices post arterial punctures has been introduced to reduce time to haemostasis, reduce haemorrhage, improve patient comfort and reduce time to ambulation. Their increased use has been a result of larger access sites for more complicated procedures, periprocedural anticoagulation and concomitant use of anti-platelet therapy. Although complication rates are not increased with their use as compared with mechanical compression, complications may be more severe and are an important consideration in their use. We report two cases of iatrogenic stenoses secondary to suture-mediated closure device. The first managed with open surgical repair and the second with cutting balloon angioplasty.
Australasian Radiology 01/2008; 51 Suppl:B319-23. · 0.51 Impact Factor
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The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 07/2005; 3(3):160-3. · 1.41 Impact Factor
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ABSTRACT: A meta-analysis of over 3000 patients in 1992 demonstrated that ovarian ablation in women less than 50 years of age produces a highly significant reduction in both disease recurrence and mortality. Laparoscopic ovarian ablation has been offered to premenopausal women at the University College Hospital in Galway for 12 years. A review of 136 cases with follow-up and examination of disease-free survival and mortality is presented. The influence of oestrogen receptor status on response and long-term outcome is examined. Premenopausal women over the age of 40 years were offered bilateral laparoscopic oophorectomy. This procedure was well tolerated with no serious morbidity. A significant difference in disease-free survival and reduction in mortality was observed in the oestrogen receptor positive group when compared with women with oestrogen receptor negative disease. No significant difference in disease-free survival or mortality was observed between the oestrogen receptor negative group and a comparable control group. These results have influenced our patient selection for this adjuvant treatment. A controlled prospective trial is now necessary to examine the role of laparoscopic oophorectomy in oestrogen receptor negative, premenopausal women with breast cancer.
The Breast 03/2001; 10(1):25-7. · 2.49 Impact Factor
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ABSTRACT: The predictive values of tumour markers Carcinoma-Associated Antigen CA 15-3, Tissue Polypeptide Specific Antigen (TPS) and Carcinoembryonic Antigen (CEA) in recurrence of breast cancer are unclear. The aim of this study was to examine the predictive value of these markers in our population of 1448 patients with diagnosed breast cancer. Data and mean follow-up of 4.4 years were available on 1082 women of whom 277 had documented recurrence (mean follow up 5.7 years). The recurrence free patients had a mean follow up of 3.9 years. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CA 15-3, TPS and CEA for visceral, bony and locoregional recurrence were calculated. CA 15-3 was the most sensitive marker, 68% for visceral and 69% for bony recurrence. This compared with TPS, 64% and 51% and CEA, 27% and 46% for visceral and bony recurrence respectively. The positive predictive value of CA 15-3 at 47% for visceral and 54% for bony recurrence was greater than that for TPS (visceral 25%, bony 21%) or CEA (visceral 18%, bony 26%). The sensitivity of CA 15-3 and TPS for locoregional recurrence was low at 23% and 17% respectively. A combination of CA 15-3, TPS and CEA failed to increase the sensitivity of CA 15-3 for visceral recurrence. However, a marginally increased sensitivity was recorded for combined CA 15-3 and TPS (70%) and for combined CA 15-3, TPS and CEA (71%) in bony recurrence. The mean lead time effect in visceral recurrence for TPS and CA 15-3 were 8 and 10 months respectively. In patients with bony recurrence the mean lead time effect for TPS and CA 15-3 were 7.5 and 8.25 months. Mean lead time effect was increased to 9 and 11 months for bony and visceral recurrence respectively when CA 15-3 and TPS were combined. CA 15-3 remains the most sensitive tumour marker in breast cancer follow up with a significantly greater positive predictive value when compared to TPS or CEA. Both TPS and CEA failed to complement the sensitivity of CA 15-3 when measured in combination.
The Breast 11/2000; 9(5):277-80. · 2.49 Impact Factor
